A reanalysis: Do hog farms cause disease in North Carolina neighborhoods?

A 2018 publication reported that communities living near hog Concentrated Animal Feeding Operations (CAFO) in North Carolina, USA have increased negative health outcomes and mortalities. While the authors stated that the associations do not imply causation, speculative interpretation of their results by media and subsequent use as evidence in lawsuits caused detrimental effects on the swine industry. We repeated their study using updated data to evaluate the strength of conclusions and appropriateness of methods used with the ultimate goal of alerting on the impact that study limitations may have when used as evidence. As done in the 2018 study, logistic regression was conducted at the individual level using 2007-2018 data, while presumably correcting for six confounders drawn from zip code or county-level databases. Exposure to CAFOs was defined by categorizing zip codes into three by swine density; where, >1 hogs/km (G1), > 232 hogs/km (G2), and no hogs (Control). Association with CAFO exposure resulting in mortality, hospital admissions, and emergency department visits were analyzed related to eight conditions (six from the previous study: anemia, kidney disease, infectious diseases, tuberculosis, low birth weight, and we added HIV and diabetes). Re-evaluation identified shortcomings including ecological fallacy, residual confounding, inconsistency of associations, and overestimation of exposure. HIV and diabetes, which are not causally relatable to CAFOs, were also prominent in these neighborhoods likely reflecting underlying systemic health disparities. Hence, we emphasize the need for improved exposure analysis and the importance of responsible interpretation of ecological studies that affect both public health and agriculture.